Information about deductibles!

The discussions that don't seem to bark: In this recent post, Kevin Drum describes the state of deductibles under Obamacare.

For those who care about such things, his information will be interesting. Based upon cable news air play, that will be virtually no one.

Drum says the deductibles aren't as bad as conservatives like to say. Based upon official data, he says, "Only about a fifth [of Obamacare enrollees] had the horror-story $6,000+ deductibles that we hear so much about."

"My guess is that the majority of the people with high deductibles are the famous 'young invincibles' who are single, don't qualify for subsidies because they're fairly well off, and don't think they're going to get sick. So they buy the cheapest plan they can."

This may all be true. We'd love to see these topics discussed much more, but the truth is, nobody actually cares about this Over Here in our tribe. (Also, nobody cares about low-income schools or about what occurs in such places. Few things could be more clear. Our team lets every kind of propaganda and misinformation slide by uncorrected, unchallenged. We've done so for many years.)

Meanwhile, for what it's worth, this is what Sarah Kliff wrote in her recent report for Vox. As she starts, she's talking about a 59-year-old working class woman who can't afford to go to the doctor because of her $6000 deductible under Obamacare:

KLIFF (12/13/16): The woman was mad because her costs felt overwhelmingly expensive. These are some of the most common frustrations with the Affordable Care Act. Surveys show that high deductibles are the top complaint; 47 percent of enrollees told the Kaiser Family Foundation they were dissatisfied with their deductible.

A study from the Commonwealth Fund earlier this year found that four in 10 adults on Affordable Care Act plans didn’t think they could afford to go to the doctor if they got sick. Fewer than half said it was easy to find an affordable plan.

We have no idea how these matters shake out. We do know this—within the tents of our upscale liberal world, no one actually cares. (We exclude Drum from that judgment.)

We'd also like to return to those data we posted here last week. To simplify matters, we pulled these numbers from the craziest data set in the world, as we've been doing for years:

In the United States, government health care spending, all by itself, exceeded all French health care spending that year. If we had a liberal or progressive movement, questions like these would routinely be asked:

Given that amount of government spending, why do we have any deductibles or co-pays at all?

Given those numbers, why do we have anyone who is uninsured?

And also this:

Where is all that extra money going? When we compare our overall spending to that of France, who's siphoning all that extra money out of our national health care?

Those questions are never asked. You'll see your favorite stars on MSNBC exploring the work of the Bolshoi Ballet before you'll see any such questions pursued.

In response to Kliff's report, we liberals showed that we don't give a flying fig when 59-year-old women in Kentucky can't go to the doctor—can't afford health care. But then, we've shown for many years that we have no progressive politics at all, except the kind which lets us drop our various bombs on Those People's heads.

It's the only play we know. It's our only pleasure.

We aren't very smart and we aren't very nice. In each of those ways, our tribe has unwittingly worked, for many years, to create these deeply troubling Days of Trump.

42 comments:

If Somerby is asking these questions to call attention to the fact that we pay more for health care in the US, he could have just said that.

His questions make him sound like he doesn't understand how our economy operates compared to places like France. You cannot extract one segment of our economy, such as health care, and change its operation without changing many others because they are inter-dependent. There are many things we do differently than the people in France.

Even something as simple as the cost of food, represented by the cost of a McDonalds hamburger varies across countries. See: http://www.worldatlas.com/articles/the-world-s-most-expensive-countries-measured-by-the-big-mac-index.html. why should it? Where does our extra few dollars go for that?

I am very tired of Somerby asking useless questions that he never answers. Of course everyone thinks they cannot afford health care. The % is the same as the number of people who live hand-to-mouth and cannot save. They spend as much as they make and when they make more, they spend more. I consider it a lifestyle choice and an aspect of psychology, not of economics, since this happens at nearly all economic levels right up the line, until you reach the wealthy.

Whining about deductibles is not an accurate measure of the success of Obamacare. I will bet that people do the same whining about their car insurance deductible and their renter's or homeowner's insurance deductibles (if they own one). Everyone would love to pay less and get more. These are the same people who consider schools important but vote down school bond measures. We all want a cheaper hamburger.

According to your Big Mac index, Switzerland spends 50% more on Big Mac's than the US -- but their healthcare is still 40% cheaper. What's inane is your comparison of healthcare to Big Mac's. US healthcare is over-priced by any measure; you can normalize healthcare spending however you wish, that will still be the inescapable conclusion.

Nowhere did I say that health care is predicted by the cost of a Big Mac. I said that countries differ in the cost of many things because their economies and societies are different.

I would imagine a Big Mac costs more in Switzerland because of the way they pay their workers. Or maybe they use real beef. You would have to delve into the specifics to figure that out, just as you would have to delve into many specifics to figure out why US health care costs more than in Switzerland but a burger does not.

Well, there are several classes of people in this country. To start with there are people who get health insurance from their employer and there are those who don't. There are others on medicare and medicaid.

To stick with insurance though, we can compare USA 2003 to USA 2015. In 2003 for a single person, health insurance was $271.76 for 2004 this went up to $330.94 for 2005 it was $359.24 and for 2006 was $384.46 and 2012 was $669.79 and $662.04 for 2013 and $725.42 in 2015 and $792.16 for 2016.

That's 191% inflation in twelve years. Not only that but the 2016 coverage is worse than the 2004 coverage. It costs more out of pocket. That's during a time when the official inflation rate was 25%.

Interestingly, the cost of a family plan only went up by 128%.

Of course, that is just the cost for my own employer. Other companies may pay more or less. Oddly enough, after the rate jumped by another $40 a month, I dropped it and went to the exchange where I got an equivalent silver plan for only $372 a month. Compared to the $792 my employer was paying.

Even though I only used about $200 of health CARE last year for the $4,500 in insurance costs, this year my rate went up to $570 a month.

I think both of those are actually good questions. 1) why are we paying so much for health care? 2) why isn't anybody talking about it?

"Nowhere did I say that health care is predicted by the cost of a Big Mac. I said that countries differ in the cost of many things because their economies and societies are different. "

So, you're just saying that things cost different amount in different countries. Brilliant. That's why the cost of healthcare typically is normalized in many different ways, e.g. per capita expenditures, in relation to GDP, etc. However you do it, in the US we are getting fleeced by (a) doctors (b) for-profit hospitals (c) medical device manufacturers (d) pharmaceutical companies (e) insurance carriers.

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Would any woman in France refuse to see a doctor for preventative care because she is afraid of what the doctor would find?

If the answer to this is multiplied many times and France's population is able to treat and prevent illnesses at earlier stages, might that reduce their overall health care costs, reducing the per person cost for everyone?

How does France suggest, encourage, compel people to see a doctor early on instead of waiting until they are carted to the doctor in an ambulance? Would those techniques work on this woman in Kentucky if tried here? Why haven't they yet?

Is it possible that Americans really are dumber than people in other countries when it comes to health practices (diet, walking, substance abuse) producing a difference in the cost of treating the resultant problems? Or is it all the fault of those ratty doctors and their inflated pay?

Free service screenings? You believe propaganda. When I asked for it I was laughed at. My bill for exam - no breast or vaginal exam - just bending my knees & elbows was &355; a simple one tube of blood test was $970. I've never been back & it's been 3 years. Thanks for caring enough to read this missive from the front lines.

From the POV of virtue-signaling, it doesn't matter much how well Obamacare actually works.

Conservatives accuse liberals of being motivated by "virtue-signaling". Supporting Obamacare shows that one cares. Those who support it can feel virtuous and consider the program's opponents evil.

This dynamic is clearer in the issue of climate change. The programs supported by President Obama and the EPA won't work. The models show that these programs won't reduce CO2 enough to make a noticeable impact on global warming. But, those who support these programs can feel morally superior. That's what counts.

Why do conservatives develop these ugly views about the motives of liberals? All humans engage in "virtue-signaling" of some sort. We may define virtue differently. But actually enacting legislation that helps people is more than signaling.

The programs enacted by Obama and the EPA have already produced measureable effects on climate (together with similar efforts around the world). Here we have an example of someone reasoning with an entirely different set of "facts." I'm sure there are some aspects of climate that have not been impacted but there are others that suggest we are making a difference with the global changes. If climate change is caused by human activity, it can be affected by changes in human activity. You need to assume that human activity does not cause climate change to conclude that the efforts to modify our rate of change may be futile. That's where reasoning for a different, wrong set of facts can cause real damage to our planet.

I'm sorry, 6:59, but the numbers don't support your belief. The mathematical models used by the IPCC show that the CO2 reductions to date have not been sufficient to make any measurable effect on climate.

I apologize for answering your rhetorical question. Supporting legislation that helps people is praiseworthy. Conservatives accuse liberals of virtue-signalling, because they believe that liberals sometimes support legislation that seems to help people, but which actually does more harm than good. Minimum wage and rent control are examples. These programs do help some individuals, but most economists think they do more harm than good.

David you make inaccurate claims. Regulations on pollution have had many positive effects. US CO2 regulations alone may not be enough to prevent climate change, but they are still completely necessary within the global context, aside for all the local benefits they provide. Regulating CO2 in the US is just one part of process. There is no logic to your reasoning if you think we should abandon regulating pollution.

David in fact most economists do not think minimum wage is a bad thing, those that do are partisans which shades their view.

I don't know what Drum is talking about when it comes to lower deductibles being available. For instance, it looks to me like the 59 year old woman with a husband of unspecified age in Corbin, Kentucky and with a household income of $41,800 is covered in 2017 with a Silver Plan, specifically:

This is way out if line with Drum's national averages. It has been acknowledged that there may be people living in areas not well-covered by a range of reasonable plans. This woman seems like one of those people and she was probably selected for that reason. But how typical is she? How much of her coverage problem is due to Obamacare?

That sounds crazy for a silver plan. Is that really silver in Kentucky? My own plan in Kansas is silver and it has a deductible of $1,250 person/$2,500 family for in-network.

Does that have something to do with her age? Do I pay less for being under 55?

Drum says "ONLY about 1 in 5" have high deductibles. Which is ONLY 2.5 million families (or people)

To me, $41,800 sounds like a lot of money even for a couple, and that they ought to have $10,000 in savings, especially at their age. A friend of mine that I was trying to help says he makes $21,000 a year and that after the subsidy a bronze plan would cost him $200 a month. That's just to insure his wife, since he is on disability and thus gets medicare. He does not see the point of paying $200 a month for a %6,000 deductible.

Cannot say I blame him, although my own 3 day hospital stay cost $12,000 in 2005.

CMike, It is good that you write down the relevant numbers.But for a Silver plan is the deductible /OOP max not less, something like 2000 or 3000?For me in California, I have a Bronze plan with deductible 6,500. As I was lucky enough to have some income, my family (spouse ~59, college kids 22,24; I myself are on Medicare-not counted) does not get any subsidy, and we paid in 2016 ~$1,000/month (in 2017 $1,150/mo) premium. The next better Silver plan is about ~1,000/month more expensive. Unfortunately, last year daughter indeed used us the total deductible, making our annual medical cost > 21k$ (~12 k premium, + 8k ded/copay), a lot of money if you are just a bit over the subsidy limit.So I can understand if someone thinks, even with insurance, you cannot go to the doctor except for the free checkup.The high premiums and deductible are, of course, the result of the U.S. healthcare system and exist both in the private market and Obamacare. But many people cannot distinguish the two, and blame Obamacare.-- Going from major employer to a small employer to Obamacare, I noticed that every step for the same premium, deductibles and co-pays increased, so the promise of greater market power vis-a-vis insurance cos by the exchanges is not quite realized.-- Perhaps the Democrat's failing is not Obamacare, but advertising it as a success; they should have said that is the best we could do, in face of Republican/ Conservative Dem/Insurance Co obstruction, and we would want to do it better.

Dr. T: ...A friend of mine who I was trying to help says he makes $21,000 a year and that after the subsidy a bronze plan would cost him $200 a month. That's just to insure his wife, since he is on disability and thus gets medicare. He does not see the point of paying $200 a month for a $6,000 deductible.

Cannot say I blame him...

CMike: Me neither.

@2:52 AM: ...I have a Bronze plan with a $6500 deductible. As I am lucky enough to have some income, our family (my spouse ~59 and two college kids 22,24; with me covered by Medicare) does not get any subsidy. We paid a ~$1,000/month premium in 2016 (and now $1,150/mo in 2017). The next better Silver plan is about ~1,000/month more expensive.

Unfortunately, last year my daughter used up the total deductible, making our annual medical cost more than $21,000 (~12 k premium + 8k ded/copay), a lot of money if you are just a bit over the subsidy limit.

So I can understand if someone thinks, even with insurance, you cannot go to the doctor except for the free checkup....

CMike: It's the people who say they can't understand this who I don't understand.

Over the course of my life there have been so many expenses that I cannot afford. You have to come up with the money anyway because to go without is unacceptable.

Examples: When I was unemployed for 6 months, I could not afford the rent on my 2 bedroom apartment. I could not afford Christmas presents for my daughter, then 4 yo. When I had cancer, before Obamacare or any other plan for the self-employed, I could not afford the monthly health insurance of over $1000 per month, but I paid it anyway. When I was divorced and my car failed, I still needed to get to work every day. I paid off a car at 19% interest because I had no credit rating as a divorced woman.

How did I find the money to do the things I couldn't afford? Sometimes I borrowed from relatives. Sometimes I worked an extra job. Always I sacrificed things that other people considered necessities.

That's what responsible people do. So, no, I cannot understand someone who thinks they cannot go to the doctor because the doctor might find something that needs treatment. And no, I cannot understand the people who complain about the things they cannot afford, as if life for them should be different than it is for so many of us.

Life is a struggle. When there is help, it is a blessing, not something to whine about. What is the point of paying $200 a month for a $6000 deductible? You'll find out. No one gets out of this life alive.

If that were such a good thing at the material level then rich people would have it set up so that their descendants wouldn't be able to inherit their wealth. Americans are born into, or have been accepted into, a rich society. Why shouldn't each of them benefit from an inheritance that includes a K through undergraduate school education if they want it, and high quality medical care throughout their life?

Liberals, Progressives, Democratics generally want single payer (or tightly regulated insurance), universal healthcare. That is not going to happen on a federal level within the current political context - Republicans control the legislative process. California has come close to passing single payer (was passed but vetoed twice by Gov Arnold Schwarzenegger) and maybe interest will renew with ACA repeal.

The 59 year old lady in Kentucky may represent a concern that needs addressing, although less so amongst the 80% of enrollees with more affordable deductibles. What she does not represent is a health care related reason for Hillary's loss to Trump. I think, as others have pointed, her claims are suspect with regard to relating her health care coverage to how she voted. She does in fact have many options to lower her deductible, for example she could choose the Caresource Gold that has just a $2500 deductible and an increase of only $240 per month to her premium (considering her income a rather modest concern).

She could increase her total annual premium by a guaranteed $2880 (6.9% of the couple's gross annual household income- what you call a modest concern) in order to decrease her annual deductible by $3650? Yeah, she could do that. Can you think of any reason she might not choose to do that?

[Looks to me like the premium increase to the Federal Simple Choice Gold plan is $262/month $3144/yr (7.5% of the household's gross income) but that's for an embedded Individual Deductible of $1250 (vs. $6150) and a max Individual out-of-pocket of $4750 (vs.$7000).]

Yes another good option she could take C Mike! (I believe their income is $40,400).

Yes I think she choose her plan on purpose because it fit her needs the best. I think her concern over her deductible is false and a ruse to hide the real reasons she voted for Trump. I do think deductibles are a concern; however, with ACA the situation is vastly superior to what we had prior. Eventually I am hopeful elected officials will turn to the single payer option. I live in CA which is basically it's own country and liberal, so maybe!

I think the big political problem with the ACA/Obamacare compliant exchange policies is that the Democrats weren't more aggressive in explaining that the non-group policies people were paying for previously was junk insurance that wouldn't have done them much good if they had met up with a wide-range of foreseeable medical problems. Likely the junk insurance was cheaper, and it did give the policy holder some peace of mind as long as they didn't have to use it but the ACA policies are a much better deal.

The problem the Democrats created in their strategy to sell the ACA was that, in an attempt to save privatized insurance they weren't willing to attack it, or even represent it as a compromise, while putting single payer on the table at the outset and the ACA only with a public option as their compromise position.

Truth be told, the Democratic leadership wanted to save private insurance, that's why they did what they did. The ACA is the industry's preferred policy, and at some point after Chief Justice Roberts had originally decided to rule against its constitutionality it was communicated to him that that powerful interest wanted a decision in the ACA's favor.

Bob asks, "Where is all that extra money going? When we compare our overall spending to that of France, who's siphoning all that extra money out of our national health care?"

That's a great question. I would assume that there are health policy experts who have studied the question, who could tell us the impact of various factors, such as higher pharaceutical prices in the US, malpractice insurance and the extra treatments caused by malpractice lawsuits, higher salaries for various health care workers, etc. And, maybe Americans are getting somewhat better care.

All this stuff is more or less measurable. There are people who know the answer. But, the public never sees the answer. Our media don't seek it out. I wonder whether people in power who create policy know the answer. Maybe policy created via the POOMA method.

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